使用重建骨板版模於廣泛上顎骨切除後重建手術規劃－病例報告

Using Reconstruction Plate Template for Reconstruction Planning after Extended Maxillectomy-A Case Report

王天祥(Tien-Hsiang Wang) ； 馬旭(Hsu Ma)

《臺灣整形外科醫學會雜誌》 19卷3期 (2010/09) Pp. 283-289

https://doi.org/10.7096/TJTSPS.201009.0283

摘要

背景：
當上顎出現缺損，整形外科醫師選擇腓骨游離皮瓣進行重建時，需要準確的量測骨骼缺損大小及輪廓，並使用骨鋸分段鋸開腓骨，希望能塑造良好的骨皮瓣外形，以恢復病人的外觀及功能。
重建骨板版模外觀類似於下顎骨手術所使用的重建骨板，是一種可彎折的軟質合金體，用途是幫助醫師模擬骨骼外形，在手術進行時作爲參考。
目的及目標：
醫師能使用版模測量上顎缺損部位的外形，輔助設計適當的腓骨皮瓣，讓病患得到良好的重建。
材料及方法：
一位罹患雙側上顎惡性腫瘤的病患，接受廣泛上顎骨切除手術後，整形外科醫師使用腓骨游離皮瓣重建缺損部位。醫師利用重建骨板版模測量骨骼缺損範圍，並模擬皮瓣外形與鄰近組織的相關位置，以設計適合的皮瓣外形，重建病人的上顎及軟組織。
結果：
病患術後14個月追蹤，外觀輪廓對稱，左下眼瞼有外翻情形，沒有複視現象。除了說話略帶鼻音與進食食物部分回流之外，病患可以恢復大致滿意的日常生活功能。
結論：
適當的使用重建骨板版模可以幫助重建醫師進行較爲複雜的上顎骨重建手術規劃。相較於目前應用的術前規劃方式，這是一種簡便而經濟的方法，並不增加額外費用。

關鍵字

上顎骨重建 ； 腓骨游離皮瓣 ； 重建骨板版模 ； 口腔癌

並列摘要

Background:
Using the free fibula flap for maxilla defect reconstruction is a challenging task. In order to restore the facial profile as well as functions of the patient, the maxilla defect has to be carefully measured and the fibula bone must be precisely osteotomized to fit in the maxilla defect. The reconstruction plate template is a pliable alloy template for measuring the curvature of the bone and being used as a reference guide for bending the bone plate during maxillofacial reconstruction.
Aim and objectives:
This article presents the details of using reconstruction plate template to measure the size and shape of maxilla defect and help surgeon design an ideal shaped fibula flap for maxilla and soft tissue reconstruction.
Materials and methods:
One patient who had mucoepidermoid carcinoma involving bilateral maxillae received extended tumor resection and was reconstructed successfully with free fibula flap. Using reconstruction plate template for measuring the maxilla defect and simulating the spatial relationship between the flap and the surrounding tissue, plastic surgeons designed an ideal shape of free fibula flap for reconstruction.
Results:
Following up for 14 months, the facial profile of the patient was successfully restored. Left lower eyelid ectropion was noticed but no diplopia was found. The swallowing and speaking functions were restored, except for partial food regurgitation during oral feeding and nasal phonation while speaking.
Conclusion:
The use of bone plate template can help reconstruction surgeons perform presurgical planning for complicated maxilla reconstructions. Compared with current methods, this is a convenient and economic way for preoperative simulation and there will be no additional cost for the patient.